Contemporary Role Research Articles

Contemporary role of the plastic and reconstructive surgeon in the outcome of female peripelvic defects after oncologic extirpation.

Reconstruction of female oncologic peripelvic defects is challenging due to complex anatomy, neoadjuvant chemoradiation, operative resection margins, and wound healing risks. Functional restoration requires thoughtful management focused on defect reconstruction and patient-reported outcomes. A retrospective chart review of peripelvic reconstruction in female patients at MD Anderson Cancer Center from 2016 to 2023. Data collected included the patient'scomorbidities, tumor characteristics, and reconstructive details. Complications were classified as nonoperative or operative within 30 days. Patient outcomes included hernia rates, sexual activity, and revision needs. In the study period, 164 patients underwent peripelvic defect reconstruction. Most had colorectal (57%), anal (17%), or gynecologic malignancies (10%). 83% had prior radiation. 33.3% had Class II or III obesity. The most common resection was open colorectal resection with partial vaginectomy (66%). Pedicled flaps (93%) were frequently used, mainly vertical rectus abdominis muscle (65%) and gracilis (11%). For multi-visceral resections, abdominal-based flaps were used in 95% of open casesand thigh-based flaps in 88.9% of robotic cases. 51% had formal abdominal wall repair. Complications occurred in 47%, with 9.1% needing surgery. Postoperative hernias were reported in 4.9%, with 3% requiring repair. Approximately 11% reported being sexually active at the last follow-up. Of those instructed on vaginal dilator therapy (42%), 24.6% were sexually active. Peri-pelvic soft tissue reconstruction in the oncologic population is safe. Operative complications and hernia rates are low. In robotic surgery, thigh-based flaps are increasingly used to reconstruct the peripelvic region. Return to sexual activity is higher in patients when given dilator therapy instruction.

The Conflicting Categorization of Kings and Chiefs in Ghana

This article aims to explore the historical development and contemporary role of the chieftaincy institution in Ghana, highlighting its enduring significance and adaptability. The institution of chieftaincy has been with the people of Ghana for centuries. Chiefs, now known as traditional rulers, are distinct from political rulers. The laws of Ghana require chiefs to maintain neutrality by forbidding their engagement in active politics. Chiefs are royals who have been validly nominated, elected, or selected by their respective kingmakers to be enstooled or enskinned according to the relevant customary law and usage. When Europeans came to Africa to trade, chiefs governed independent states, each with its own laws, courts, police, and military. The chieftaincy institution is organized hierarchically, ranging from the lowest rank to the apex, and among the Asantes, the Asantehene is the apex. Before 1901, when the British colonized the Asantes, the Asantehene served as the political, executive, and legislative head of the people of the Asante Kingdom. The Asante Kingdom covers the Ashanti Region, Ahafo Region, parts of the Bono and Bono East Regions, and a paramountcy each in Ghana’s Eastern and Oti Regions. The traditional capital of the Asante Kingdom, Kumasi, was initially at Kwaman. In the 1670s, Chief Osei Tutu from the Oyoko Abohyen Dynasty became the chief of Kwaman after succeeding his late uncle Nana Obiri Yeboah, who reigned from 1640 to 1680 and united all the Asante chiefdoms, which were independent and had their political autonomy. The occupants of the Golden Stool are designated as kings and have held the title to this day. Although the British succeeded in changing the name of some kings to paramount chiefs, they failed to change the name of the royals responsible for the nomination, election or selection of a person to be enstooled or installed as an Asantehene, paramount chief or chief, who are still called the kingmakers. Keywords: Asante Kingdom; Asantehene; enstooled; fetish-priest; Gold Coast; golden stool; kingmakers; Oyoko clan; paramount chief; traditional ruler.

Advancing health equity and the role of digital health technologies: a scoping review protocol

IntroductionHealthcare systems around the world exhibit inherent systemic inequities that disproportionately impact marginalised populations. Digital health technologies (DHTs) hold promising potential to address these inequities and to play a pivotal...

Severe acute liver disease in adults: Contemporary role of histopathology.

Liver biopsies have consistently contributed to our understanding of the pathogenesis and aetiologies of acute liver disease. As other diagnostic modalities have been developed and refined, the role of biopsy in the management of patients with acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and acute hepatitis, including acute liver injury (ALI), has changed. Liver biopsy remains particularly valuable when first-line diagnostic algorithms fail to determine aetiology. Despite not being identified as a mandatory diagnostic tool in recent clinical guidelines for the management of ALF or ACLF, many centres continue to undertake biopsies given the relative safety of transjugular biopsy in this setting. Several studies have demonstrated that liver biopsy can provide prognostic information, particularly in the context of so-called indeterminate hepatitis, and is extremely useful in excluding conditions such as metastatic tumours that would preclude transplantation. In addition, its widespread use of percutaneous biopsies in cases of less severe acute liver injury, for example in the establishment of a diagnosis of acute presentation of autoimmune hepatitis or confirmation of a probable or definite drug-induced liver injury (DILI), has meant that many centres have seen a shift in the ratio of specimens they are receiving from patients with chronic to acute liver disease. Histopathologists therefore need to be equipped to deal with these challenging specimens. This overview provides an insight into the contemporary role of biopsies (as well as explant and autopsy material) in diagnosing acute liver disease. It outlines up-to-date clinical definitions of liver injury and considers recent recommendations for the diagnosis of AIH and drug-induced, autoimmune-like hepatitis (DI-AIH).

Rola ekspertyzy wariograficznej w postępowaniu karnym

The publication in question deals with the contemporary role of polygraph exper-tise in Polish criminal proceedings. It discusses the history of polygraph research. It refers to research techniques used by experts in the field, as well as to atypical cases of controversial research. Indicates the legal basis of polygraph research. Additionally, it draws attention to the issue of their evidentiary and diagnostic value. He extensively discusses the views of the Supreme Court and common courts formulated in this matter from 1963 to the present. Finally, it emphasizes the role of standardization of polygraph research and popularizing knowledge about it among lawyers.

Central Neck Dissection in Papillary Thyroid Carcinoma: Benefits and Doubts in the Era of Thyroid Lobectomy.

Surgery is still the main line of treatment for papillary thyroid cancer (PTC) with a current trend for de-intensified treatment based on an excellent prognosis. The role of a routine prophylactic central neck dissection (PCND) is still debated as its impact on oncologic outcomes has never been cleared by a randomized clinical trial. In this study, we aimed to report our long-standing experience in PCND and its potential contemporary role in the treatment of PTC. A retrospective institutional review was performed on all patients who underwent operation for PTC including PCND between 1998 and 2021. The primary outcomes were the rate of central lymph node metastases (CLNMs), cancer recurrence and incidence of complications. Survivals were analyzed using the Kaplan-Meier estimator and Cox proportional hazard models. A total of 657 patients were included in this study with a median follow-up of 78 months (48-114 months). Two hundred and one patients presented occult CLNMs (30.6%). The presence of a pathological node represented the unique reason for a completion thyroidectomy and I131 therapy in 12.5% of the population. Age lower than 55 years, microscopic or macroscopic extra-thyroid extension (ETE) and multifocality were independent factors predicting CLNMs. The rate of recurrence in the whole population was 2.7% (18 patients). Five-year and ten-year disease-free survival (DFS) was 96.5% (94.7-97.7) and 93.3% (90.3-95.5), respectively. Two patients relapsed in the central neck compartment (0.3%). Age (>55 years), pathological staging (pT) and extranodal extension (ENE) were independent factors associated with a worse DFS. The rate of temporary and permanent vocal fold palsy was 12.8% and 1.8%, respectively, and did not depend on the type of surgical procedure performed. Hypoparathyroidism was temporary in 42.2% and permanent in 11.9% of the patients. A sub-analysis upon cT1b-T2 patients treated primarily with thyroid lobectomy and ipsilateral PCND demonstrated a 2.6% rate of permanent hypoparathyroidism. PCND allows for a high disease-free survival and a proper selection of patients needing adjuvant treatment, in particular, those treated with a unilateral procedure. On the other hand, bilateral approach is burdened by a not-neglectable rate of permanent hypoparathyroidism.

Diversity, Equity, Inclusion, and Belonging Framework in the Cultivation and Consumption of Kalanamak Rice: A Case Study

This research article examines the dimensions of Diversity, Equity, Inclusion, and Belonging (DEIB) in the cultivation and consumption of Kalanamak rice (KNR), a heritage and indigenous agricultural product of India. It explores the historical and contemporary roles of KNR in promoting or hindering DEIB within its cultural and agricultural contexts. The research is a unique attempt to construct the DEIB framework in KNR by using secondary resources and qualitative personal interview data, applying the grounded theory approach. The study provides insights into a rarely studied heritage/indigenous crop in India concerning the DEIB framework in its cultivation and consumption. The case study of KNR indicates that the equity and integration of marginal communities in KNR fall short of the desired level. Nonetheless, there is an acknowledgment of the necessity for progress in establishing a DEIB framework. Challenges such as insufficient financial resources and expertise, stemming from a prevailing power and privilege imbalance, are a threat to DEIB in KNR and need to be addressed by policymakers for the benefit of stakeholders. The article also highlights some of the government interventions to improve the DEIB of the KNR farmers and communities.

National Cultures in Times of Digital Transformation of the Travel Industry: Qualitative Exploration of Effects on Digital Business Models

Globalization and digitalization raise questions about the contemporary role of national culture. Investigating digital business models (BMs) in the travel industry, this study clarifies the effects of national cultures on them. Thirty-nine impactful aspects of national cultures— 25 institutional and 14 ideational—are identified based on qualitative research. These aspects are derived from various cross-cultural frameworks and include three newly suggested cultural dimensions. The proposed model clarifies the mechanism of the impact. The study restates the significance of national cultures in the digital era and places emphasis on the importance of both institutional and ideational sides of national cultures. The study would be helpful to practitioners in deciding on suitable places for a business opening and localizing BMs across international borders.

The Historical Origins and Contemporary Role of the Endoscopic Treatment for Urethral Stricture Disease

The Historical Origins and Contemporary Role of the Endoscopic Treatment for Urethral Stricture Disease

Musculoskeletal Disorder (MSD) Health Data Collection, Personalized Management and Exchange Using Fast Healthcare Interoperability Resources (FHIR).

With the proliferation and growing complexity of healthcare systems emerges the challenge of implementing scalable and interoperable solutions to seamlessly integrate heterogenous data from sources such as wearables, electronic health records, and patient reports that can provide a comprehensive and personalized view of the patient's health. Lack of standardization hinders the coordination between systems and stakeholders, impacting continuity of care and patient outcomes. Common musculoskeletal conditions affect people of all ages and can have a significant impact on quality of life. With physical activity and rehabilitation, these conditions can be mitigated, promoting recovery and preventing recurrence. Proper management of patient data allows for clinical decision support, facilitating personalized interventions and a patient-centered approach. Fast Healthcare Interoperability Resources (FHIR) is a widely adopted standard that defines healthcare concepts with the objective of easing information exchange and enabling interoperability throughout the healthcare sector, reducing implementation complexity without losing information integrity. This article explores the literature that reviews the contemporary role of FHIR, approaching its functioning, benefits, and challenges, and presents a methodology for structuring several types of health and wellbeing data, that can be routinely collected as observations and then encapsulated in FHIR resources, to ensure interoperability across systems. These were developed considering health industry standard guidelines, technological specifications, and using the experience gained from the implementation in various study cases, within European health-related research projects, to assess its effectiveness in the exchange of patient data in existing healthcare systems towards improving musculoskeletal disorders (MSDs).

How should non-emergency EMS presentations be managed? A thematic analysis of politicians’, policymakers’, clinicians’ and consumers’ viewpoints

ObjectiveIn 2023, Australian government emergency medical services (EMS) responded to over 4 million consumers, of which over 56% were not classified as an ‘emergency’, at the cost of AU$5.5 billion....

Aesthetic Transcendence: Fashion's Evolution, Philosophical Reflections, and Societal Impact

This research paper explores the evolution of fashion from its utilitarian origins over 170,000 years ago to its contemporary role as a symbol of cultural expression and individual identity. Tracing the historical trajectory through ancient civilizations, the Renaissance era, and significant societal shifts post-World War II, the study highlights the dynamic interplay between culture, external forces, and fashion. It also delves into the commodification of beauty in the contemporary era, examining the persuasive techniques used by beauty brands in advertisements, such as leveraging emotional states to connect deeply with consumers. The global impact of beauty standards and the perpetuation of white-centric ideals are scrutinized, emphasizing influential figures like Marcus Garvey, who challenged these norms. The study sheds light on the beauty industry's promotion of skin-lightening and hair-straightening products, particularly in Asian markets, and offers philosophical reflections on these beauty standards. Engaging with the works of Hume, Kant, Santayana, and Schiller, the paper dissects the subjective and objective dimensions of beauty, including Hume's emphasis on pleasure and pain, Kant's categorization of beauty, Santayana's concept of objectified pleasure, and Schiller's influence on German Idealism. It culminates with an exploration of Jean Baudrillard's "Death of the Real," examining the implications of a society immersed in creating identities detached from objective reality. This paper weaves together the historical evolution of fashion, beauty brand strategies, and philosophical reflections on beauty, offering a nuanced understanding of the complex relationship between aesthetics, identity, and societal perceptions.

Demystifying the Contemporary Role of 12-Month Dual Antiplatelet Therapy After Acute Coronary Syndrome.

For almost two decades, 12-month dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) has been the only class I recommendation on DAPT in American and European guidelines, which has resulted in 12-month durations of DAPT therapy being the most frequently implemented in ACS patients undergoing percutaneous coronary intervention (PCI) across the globe. Twelve-month DAPT was initially grounded in the results of the CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) trial, which, by design, studied DAPT versus no DAPT rather than the optimal DAPT duration. The average DAPT duration in this study was 9 months, not 12 months. Subsequent ACS studies, which were not designed to assess DAPT duration, rather its composition (aspirin with prasugrel or ticagrelor compared with clopidogrel) were further interpreted as supportive evidence for 12-month DAPT duration. In these studies, the median DAPT duration was 9 or 15 months for ticagrelor and prasugrel, respectively. Several subsequent studies questioned the 12-month regimen and suggested that DAPT duration should either be fewer than 12 months in patients at high bleeding risk or more than 12 months in patients at high ischemic risk who can safely tolerate the treatment. Bleeding, rather than ischemic risk assessment, has emerged as a treatment modifier for maximizing the net clinical benefit of DAPT, due to excessive bleeding and no clear benefit of prolonged treatment regimens in high bleeding risk patients. Multiple DAPT de-escalation treatment strategies, including switching from prasugrel or ticagrelor to clopidogrel, reducing the dose of prasugrel or ticagrelor, and shortening DAPT duration while maintaining monotherapy with ticagrelor, have been consistently shown to reduce bleeding without increasing fatal or nonfatal cardiovascular or cerebral ischemic risks compared with 12-month DAPT. However, 12-month DAPT remains the only class-I DAPT recommendation for patients with ACS despite the lack of prospectively established evidence, leading to unnecessary and potentially harmful overtreatment in many patients. It is time for clinical practice and guideline recommendations to be updated to reflect the totality of the evidence regarding the optimal DAPT duration in ACS.

The Contemporary Role of Salvage Radical Prostatectomy in the Management of Recurrent Prostate Cancer: An Up-to-Date Review.

Prostate cancer is the second most common cancer among men, with many treatment modalities available for patients, such as radical prostatectomy, external beam radiotherapy, brachytherapy, high-intensity focused ultrasound, cryotherapy, electroporation and other whole-gland or focal ablative novel techniques. Unfortunately, up to 60% of men with prostate cancer experience recurrence at 5 to 10 years. Salvage radical prostatectomy can be offered as an option in the setting of recurrence after a primary non-surgical treatment. However, the complexity of salvage radical prostatectomy is considered to be greater than that of primary surgery, making it the least popular treatment of choice. With the wide use of robotic platforms in urologic oncologic surgery, salvage radical prostatectomy has attracted attention again because, compared to past data, modern series involving salvage Robot-Assisted Radical Prostatectomy have shown promising results. In this narrative literature review, we comprehensively examined data on salvage radical prostatectomy. We investigated the correlation between the different types of primary prostate cancer therapy and the following salvage radical prostatectomy. Furthermore, we explored the concept of a robotic approach and its beneficial effect in salvage surgery. Lastly, we emphasized several promising avenues for future research in this field.

Consciousness and the other: Fragmentation, unselfing, and a contemporary role for the modernist collage interview

ABSTRACT This article utilizes the form of a creative writer’s craft interview – a popular example is The Paris Review’s “Art of Fiction” series – to explore the interview as a tool in creative writing practice. The mock interview – the author is both interviewee and interlocutor – allows the author to interrogate how interviewing functions as a means of exploring identity and so reorients them to another subject’s pain and experience. In addition, the author examines Muriel Rukeyser’s use of collaged fragments of interviews in her The Book of the Dead and includes a discussion of the poet Philip Metres’s writings on documentary poetics as a means of thinking through new ways for them – and any creative writer – to incorporate the interview as a tool. The article ends with the importance of the collage-interview, in the age of ChatGPT, for preserving language complexity and of representing experiences beyond the author’s imagination and experience.

Techno-Realism: Navigating New Challenges in the Contemporary Role of Technology in Politics

This paper aims to introduce a new theory, techno-realism, which is derived from political realism, to help comprehend the complex connections between technology and politics. According to techno-realism, technology serves as a means of power, with the innate drive for survival in human nature shaping the formation of identity. The research question at the core of this study revolves around the extent to which technology influences contemporary political science and whether it truly serves as a means of power. Three concepts are introduced: identity establishment, technology as the central source of power, and non-state actors in politics. The primary case study focuses on the complexity of the issue in Xinjiang, examining the application of cyberpolitics in the region. The second case study explores technology’s role in Indonesia’s political power struggle, as evidenced by its 2024 elections and the abuse of information and electronic transaction law effectiveness to control freedom of speech. Additionally, this paper introduces a case study on the Indo-Pacific regional power dynamics in confronting “digital authoritarianism”. This paper underscores the imperative for a new theoretical framework, adapted from political realism, which despite being subject to considerable criticism, has the potential for further development, placing technology at the core of analysis. Recognising the central roles of technology, identity formation, and non-state actors, techno-realism offers valuable insights for navigating complex political landscapes and informing strategic responses to emerging challenges. However, further research is needed to understand completely its applicability and limitations across different contexts, as demonstrated by the case studies presented in this paper.

The Modern Trends in Internal Auditing and Their Role in Enhancing the Efficiency and Effectiveness of Performance in Governmental Units

This research aims to explore and analyze the modern trends of internal auditors in the Iraqi public sector and their role in enhancing the efficiency and effectiveness of performance, with the objective of developing their professional practices. It examines how recent advancements, such as advanced technology and risk-based practices, improve the efficiency and effectiveness of internal auditing within the governmental environment. The study provides data-supported recommendations for policymakers and managers in governmental units to enhance transparency and efficiency through the adoption of best global practices. To achieve the research objective, the researcher designed a questionnaire containing (47) variables distributed across three axes. The first axis (fundamental trends of internal auditing) included (22) items covering aspects of this axis. The second axis (the contemporary role of internal auditing in risk management) comprised (3) main items and (15) sub-items covering all variables of this axis. The third axis (the reflection of internal auditing in improving the efficiency and effectiveness of the economic unit) included (10) items. The study reached several conclusions, the most significant being that internal auditing according to modern trends is not limited only to assessing compliance and financial control, but its role extends to vital aspects such as risk classification, risk management evaluation, and fraud and fraud prevention. Internal auditing is a crucial tool not only in control and compliance but also in enhancing efficiency and effectiveness within institutions.

Contemporary Role of Open Left Thoracoabdominal Approach in Esophageal Malignancy Treatment.

Despite the widespread use of minimally invasive techniques, open left thoracoabdominal esophagectomy (LTE) can offer excellent visualization and adaptability. The current study aimed to present and evaluate the outcomes related to an open LTE in esophageal malignancy treatment. A retrospective cohort analysis of data collected from two institutions was performed, including patients with distal esophageal or junctional tumors who underwent open LTE between November 2018 and December 2023. Twenty-two patients were included (16 males; mean age 62.8 years). Postoperative complications occurred in eight patients (36%), with pulmonary complications being the most prevalent (seven patients; 32%). One patient experienced a clinical anastomotic leak. No reoperations or escalation to a higher level of care were required. In-hospital and 30-day mortality were zero. Tumor cells were found at the surgical margins in six patients (27%). The mean lymph node yield was 27. During the follow-up period, there were nine deaths and 11 cases of disease recurrence. Isolated locoregional recurrence was seen in five patients (23%). The one-year and two-year overall survival rates were 79% and 47%, respectively. In selected cases, open LTE remains a valid and safe operation with acceptable morbidity and oncological efficacy.

Transcatheter PFO closure for cryptogenic stroke: current approaches and future considerations.

Patent Foramen Ovale (PFO) is a common congenital atrial septal defect present in 20%-35% of the general population. Although generally considered a benign anatomic variant, a PFO may facilitate passage of a thrombus from the venous to arterial circulation, thereby resulting in cryptogenic stroke or systemic embolization. A PFO is detected in nearly one half of patients presenting with cryptogenic stroke and often considered the most likely etiology when other causes have been excluded. In this review, we discuss the contemporary role of transcatheter closure of PFO in the treatment of cryptogenic stroke, including devices currently available for commercial use in the United States (Amplatzer PFOTM Occluder and GoreTM Cardioform Septal Occluder) and a novel suture-mediated device (NobleStitchTM EL) under clinical investigation. To provide the best care for cryptogenic stroke patients, practitioners should be familiar with the indications for PFO closure and corresponding treatment options.

Shaping citizens: teachers enacting democratic education in the history classroom

AbstractThe work of history teachers in schools is contentious and often heavily scrutinised, characterised by conflicts between professional and ideological perspectives on the purpose of the work they do (Macintyre & Clark, 2003). History curricula in Australia have been the subject of regular, ongoing political intervention, in particular about the role of history education in constructing and maintaining narratives of Australian democracy and citizenship. Against this landscape, this paper explores how history teachers from New South Wales, Australia conceive of the contemporary role of history curriculum in the development of students’ understanding of civics and democracy, and their navigation of the tensions between the written curriculum and the contexts in which they teach. Using both observational and interview data, this paper explores teachers’ perceptions of the gap between curriculum “as intention and as reality” (Stenhouse, 1975, p. 2) illuminating the experiences of teachers who interact with and implement the curriculum in their daily work, and highlighting the role that school context plays in determining how civics and citizenship education is enacted in practice. Contrast is offered between the teachers of history in the context of a privileged, urban school community, to that of an Aboriginal teacher working in a regional context - with an exploration of the impact of these contexts in framing the possibilities for democratic and civic engagement in the history classroom. Using the theoretical framework of practice architectures (Kemmis & Grootenboer, 2008), I explore the role of curriculum as both an enabling and constraining force in the way teachers work to develop student understandings of democracy and civic identity and the complex relationship that emerges from teachers’ interaction with curriculum documents and their decision-making in relation to their students and communities.